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2016 Individual Health Policy – Doctors Are Not Accepting even though you checked!

Recheck your doctors are in network/accepting your 2016 Individual Health Policy, before enrollment period ends on 1/31/2016. Some directory errors can leave you without your doctor accepting

Clients find their doctor is not accepting their Individual Insurance

your insurance.

Shopping for individual insurance for 2016 has been quite different than in the past year. During the initial enrollment period starting in November 2015 there was mostly HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans on the market. These are closed network plans that does not allow members to go out of the provider’s network for any medical services. All the major insurance companies Aetna, BCBS, Humana and United Health Care removed their PPO (Preferred Provider Network) plans from the market removing the flexibility to go to any doctor (in or out of network) while allowing self-referring to any specialist and smaller networks of providers that require referrals to specialists from the Primary Care Doctor. HMOs and EPOs do not allow out of network coverage.

The biggest challenge for people shopping for insurance is finding plans that will allow members to keep their doctors in 2016 on the available plans. This has been a challenge for many of our customers to find the plan that works. We have had a client that had seven doctors and they were forced to change all of them because no plan offered any of their doctors in network. The end result for this client was she had to accept changing all of her doctors. They as well needed to change from the flexibility of a PPO plan to a HMO or EPO.

We have as well found that the systems on the carrier’s website we used to check if your doctor was participating in a company’s network to select a plan may have been outdated or incorrect. This makes it very important to take the time to confirm that your doctors accept the plan you selected for 2016. We have had numerous clients contact us that they found out that their doctor does not take their insurance.

We have also discovered that some doctors will not accept any individual insurance, so that leaves loyal patients in a situation to decide if they should pay cash outside of their insurance to keep their doctor. Some of our clients do not have the means to do that so they will be forced to change to a new doctor.

If you are not satisfied with your health insurance choices and you own an LLC or small business a group insurance plan may be the answer to be able to get a PPO/POS plan that you were used to before this year. Ask an insurance agent broker about details to see if you can put a group together with your company.

For others take a few minutes to confirm with your doctor they really do accept the insurance plan you signed up for. You want to do this before the annual enrollment window closes. Once you miss the January 31 2016 date to select a plan, you will be stuck with this insurance for the entire year.

If you are not happy about the state of individual health insurance and the offerings, this is a good time to let your elected officials know what you are going through with your health insurance. I really do not think they know what the American people are having to deal with.

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